Provider Demographics
NPI:1225546203
Name:GOLDEN CORRIDOR FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
Entity Type:Organization
Organization Name:GOLDEN CORRIDOR FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURISEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-760-7022
Mailing Address - Street 1:300 W WISE ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193
Mailing Address - Country:US
Mailing Address - Phone:847-891-9622
Mailing Address - Fax:847-891-8901
Practice Address - Street 1:300 W WISE ROAD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193
Practice Address - Country:US
Practice Address - Phone:847-891-9622
Practice Address - Fax:847-891-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty